Many active baby boomers will experience shoulder pain at some point in their life.  At times it is related to athletic activities but often, they don't recall a specific incident that spurred the problem. They may have just woken up feeling a "twinge" in the shoulder or noticed sudden loss of range of motion.

Unfortunately, the shoulder becomes increasingly susceptible to injury with the passing of time, largely because of deteriorating shoulder joint mechanics. It's not usually a blow or fall that draws the baby boomer into the throes of this kind of injury. Instead, onset is often cumulative, making a diagnosis somewhat complicated.  Most commonly, patients we see are diagnosed with rotator cuff syndrome, osteoarthritis or frozen shoulder—and sometimes all three simultaneously.

Shoulder Anatomy and Biomechanics 
The shoulder joint is the most mobile joint in the body. Therefore, it's susceptible to more subluxations, dislocations and wear-and-tear injuries than any other joint.
Imagine a golf ball sitting on a tee. This is the analogy for the humeral head sitting in the general shallow and small glenoid fossa at the anterior part of the scapula. This relatively large ball on the small tee maintains stability and function for complex movements. The tee or glenoid fossa also has a ring-like structure around it called the labrum, which stabilizes the humeral head.
To keep the humeral head inside the joint during shoulder rotation, various structures, including the capsule, gleno-humeral ligaments, rotator cuff muscles and tendons, must function smoothly and in synchrony. Two bursas also help provide efficient movements.

The Cause of Pain 
Many patients do something seemingly minimal, such as putting a small suitcase in an overhead bin on an airplane or lifting groceries, and then experience immediate, sudden acute shoulder pain. Other times, the pain just appears, and patients don't remember a particular event that caused it.

Usually the cause of injury is the bony structures that wear down rotator cuff muscles and tendons over time. For this reason, we use the term rotator cuff syndrome rather than rotator cuff tendinitis, supraspinatous tendinitis or rotator cuff tear.  
Degenerative changes or impingement on the underlying supraspinatous muscle and/or tendon, often accompany rotator cuff syndrome as well.

Rotator cuff syndrome commonly affects adults over 40.  Those with a history of dislocations, subluxations and shoulder joint injuries in their youth are more likely to develop these degenerative changes in the shoulder.

Treatment

Because of the many variables with shoulder injuries, physicians generally start with shoulder X-rays and recommend physical therapy for patients with shoulder problems.  If the patient doesn't respond to physical therapy, then they do an MRI. The MRI, in addition to X-rays, physical exam and subjective complaints, helps them to form a long-term treatment plan.  Many physicians recommend surgery for patients diagnosed with full thickness tears of the supraspinatous tendon as interpreted on MRI studies.  However, physical therapy and home exercises may restore shoulder function to a satisfactory level without surgery.   Sometimes a cortisone shot can provide relief of the pain, bursitis and inflammation.

If you are experiencing shoulder pain, evaluation by a specialist who can consider surgical and nonsurgical options and has a background in sports medicine is an ideal clinician to chart the best course for patients with shoulder pain.